Environmental Tobacco Smoke

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According to the United States Environmental Protection Agency (EPA), environmental tobacco smoke (ETS), which is also referred to as secondhand smoke, is a mixture of the smoke emanating from the burning end of a cigarette, pipe, or cigar, and the smoke exhaled from the lungs of smokers. It has also been called passive, or involuntary, smoke. Although different sources may use different terms and varied definitions, the basic focus is on the exposure of a nonsmoker to the high levels of carcinogenic and toxic fumes emitted from burning tobacco.

ETS contains over 4,700 chemicals. Of these chemicals, forty-two are known carcinogenic compounds, including benzene, arsenic, nickel, nicotine, chromium 6, and vinyl chloride. Many of these compounds are added to tobacco in order to enhance burn time, freshness, and nicotine levels.


A 1996 study conducted by the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) documented that measurable levels of serum cotinine were found in the blood of 88 percent of American nonsmokers. The presence of cotinine, a chemical the body metabolizes from nicotine, shows that a person has been exposed to tobacco smoke in the last two to three days. In other words, nearly nine out of ten nonsmoking Americans are exposed to ETS on a regular basis. Furthermore, it is estimated that 50 to 75 percent of children under five years of age live in homes with at least one adult smoker.


R. J. Reynolds, the manufacturer of Camel, Winston, and other cigarette brands, has stated that they "do not believe that the scientific evidence concerning secondhand smoke establishes it as a risk factor for lung cancer, heart disease, or any other disease in adult nonsmokers" (R. J. Reynolds, "Tobacco Issues"). However, research indicates that exposure to ETS can contribute to serious health consequences and is the third leading cause of preventable death in the United States.

The EPA has classified ETS as a group A carcinogen and estimates that it causes about three thousand lung cancer deaths in U.S. nonsmokers per year. Legal challenges against the validity of this study have been filed, mostly by tobacco interests. However, the EPA stands behind its findings and has received confirmation and support from other health groups conducting similar and expanded studies. For instance, in 1997 a study conducted by the California Environmental Protection Agency linked secondhand smoke not only to lung cancer, but also to heart disease, nasal sinus cancer, and various other life-threatening diseases. Other studies have established a connection between ETS and breast cancer and stroke. Studies of the effects of ETS exposure on children (both prenatal and postnatal) have indicated higher instances of sudden infant death syndrome, low birthweight, problems with neurodevelopment, negative behavior, childhood cancer, cardiovascular disease, and negative respiratory effects such as asthma and reduced lung capacity. The EPA estimates that each year between 200,000 and 1 million asthmatic children have their condition aggravated by exposure to secondhand smoke. Children of adult smokers have been found to have higher instances of ear infections, nosebleeds, colds, and flu.


Tobacco interests concentrate on the issue of "accommodation" in the establishment of ETS policies. Philip Morris, producer of Marlboro, Virginia Slims, and other cigarettes brands, states, "We know that environmental tobacco smoke can be unpleasant and annoying, and that many people believe that it presents a health risk to nonsmokers. That is why we strongly support through a variety of actions and programsoptions designed to minimize unwarranted ETS, while still providing adults with pleasant and comfortable places to smoke" (Philip Morris USA, "Second Hand Smoke"). The tobacco industry focuses on using ventilation to remove the components of ETS that might "irritate" a nonsmoking patron, while the health community is more concerned with removing the carcinogenic or toxic elements of tobacco smoke altogether.

The bulk of scientific research supports the health communities' claims that ventilation cannot create a safe indoor environment when tobacco smoke is present. Modern ventilation systems may provide a worker or patron with a perception of protection due to an apparent decrease in tobacco-smoke irritants. However, research proves that tobacco smoke does not remain within designated smoking areas, but travels easily through a building's open doorways and ventilation system. Therefore, accommodation policies do not significantly reduce exposure to the toxins that are associated with ETS-related diseases.

Formal policies and laws restricting or banning the use of tobacco in public buildings, schools, workplaces, and places customarily utilized by the public have been enacted at the federal, state, and local levels. Early ETS policies established rules of accommodation, limiting smoking to designated locations within buildings. As information about the inadequacy of accommodation policies grows, however, public and private entities are moving toward a complete ban of tobacco use within buildings and vehicles. The ban of smoking on U.S. airplanes in 1997 was the result of the settlement of a lawsuit brought by 60,000 flight attendants who suffered the ill effects of long-term exposure to tobacco smoke while on duty.

ETS policy should also address tobacco use outside building entrances. Tobacco smoke follows the natural airflow into a building. Open doors and windows can actually attract smoke in a funneling action. Therefore, many public and private facilities are establishing a ten-to twenty-five-foot smoke-free zone around all entrances; around operating window, air conditioning, and heating intake units; and within stairwells. Some entities, such as worksites that handle flammable or hazardous chemicals, health care facilities, and schools and day-care centers, prohibit tobacco use on their entire campus (all property, both inside and outside). In 1999 the State of Arizona passed a law banning both the use and possession of tobacco products on all school K-12 campuses (private, public, and charter). This comprehensive law was in direct response to the state's concern about both the exposure to tobacco smoke and the influence of tobacco use around children.

While children can be protected from ETS exposure by laws prohibiting tobacco use in schools, day-care facilities, restaurants, and other public places, these laws do not protect children from tobacco smoke within their homes or automobiles. Since up to three-fourths of all children live with a smoker, public health professionals work to educate the general public on the importance of establishing smoke-free homes and automobiles for the safety and well-being of their children and nonsmoking family members.


Workplace smoking bans also have positive health affects on smokers, including a decrease in the overall number of cigarettes smoked per day and a higher rate of successful quit attempts. Employers and business owners instituting tobacco-free policies can save costs associated with fire risks, damage to property and furnishings, cleaning, worker's compensation, disabilities, retirement, injuries, and life insurance.

The tobacco and hospitality industry has long claimed that the passage of ordinances restricting tobacco use, particularly in restaurants, would pose an economic hardship on those businesses. However, continuing community sales tax studies have shown that communities that have enacted restaurant smoking bans have not seen a decrease in restaurant revenues.


Regulation of smoking in an effort to curb exposure to ETS has been a controversial issue in many communities. The tobacco industry and its supporters do not acknowledge that exposure to ETS compromises health. The National Smoker's Alliance is a smokers' rights group that represents the industry's interests. They contend that adults have the right to choose to smoke and that smoking restrictions impose restraints on smokers' personal rights. They also claim that regulation of smoking in private businesses infringes on the rights of business owners to decide how to best serve their customers. Public health advocacy groups counter that the adverse health effects of ETS exposure are well documented, and that while adults have the right to choose to smoke, they also have the right to clean indoor air. They frame the regulation of smoking in public and private workplaces as a worksite safety issue, arguing that nonsmokers who work in smoking environments are constantly exposed to high levels of ETS.

Exposure to environmental tobacco smoke is the third leading cause of preventable death in the United States today. According to a report released by the U.S. Surgeon General's office in August 2000, ETS may account for as many as 62,000 deaths per year in the United States from heart disease alone. Many communities have passed laws to restrict or prohibit smoking in public places and worksites in order to protect the public from the harmful effects of ETS. Policies that restrict smoking to designated smoking areas have been found to be ineffective, as tobacco smoke circulates freely into nonsmoking areas. Instituting 100 percent smoke-free policies is the most effective way of protecting workers, children, and the public from exposure to the numerous carcinogens and toxins found in tobacco smoke.

Nina S. Jones

(see also: Ambient Air Quality [Air Pollution]; Cancer; Cardiovascular Disease; Clean Air Act; Clean Indoor Air Ordinances; Disease Prevention; Environmental Determinants of Health; State Programs in Tobacco Control; Tobacco Control; Workplace Smoking Policies and Programs )


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Centers for Disease Control and Prevention. A Decision Maker's Guide to Choosing a Workplace Policy. Atlanta, GA: CDC Office on Smoking and Health.

Environmental Protection Agency (1992). Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Washington, DC: Author.

(1993). Secondhand Smoke, What You Can Do about Secondhand Smoke as Parents, Decision Makers, and Building Occupants. Washington, DC: Author.

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Jones, N. (1999). A Good Day's Work: A Guide for Tobacco Free Worksites in Arizona. Phoenix: Arizona Department of Health Services. Available at http://www.tepp.org/atin/policy/gooddaywork/index.htm.

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Philip Morris International. "Secondhand Smoke, Our Actions to Reduce Unwanted ETS." Available at http://www.philipmorrisusa.com.

Repace, J.; Kawachi, I.; and Glantz, S. (1999). Fact Sheet on Secondhand Smoke. Available at http://repace.com/factsheet.html.

R. J. Reynolds Tobacco Company (2001). "Tobacco Issues." Available at http://www.rjrt.com/TI/Pages/TIcover.asp.

World Health Organization (1999). Tobacco Free Initiative: International Consultation on Environmental Tobacco Smoke and Child Health Consultation Report. Geneva: Author.

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Environmental Tobacco Smoke

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